This invention relates to fiber optic scopes and intubation in medical, as well as potentially non-medical, applications.
It is frequently necessary in standard medical procedures to insert an endotracheal tube into the trachea of a patient for the purpose of performing diagnostic tests or for the introduction of some means of ventilation assistance. Even in the best of situations, such intubation is often difficult and can give rise to complications in the patient. Aspiration of stomach contents into the trachea and an inability to expeditiously intubate the patient, leading to significant hypoxemia, are examples of attendant complications. There have also been cases of death related to complications arising from intubation.
In many patients, intubation is particularly formidable due to morphological anomalies, such as a large tongue, excessive soft tissue, or tracheal displacement which makes it difficult to visualize the posterior pharyngeal area and larynx. In emergency medical situations, attempts to intubate such persons is difficult, time consuming, and often meets with failure. It is the purpose of the invention herein to provide a means of intubation, facilitated by an optical system, in those types of patients whose pharynx, larynx, and trachea are not easily visualized.
Devices for facilitating patient intubation through visual means have been disclosed in prior art, most notably U.S. Pat. No. 3,776,222 to Smiddy, entitled "Fiber Optic Entubator and Method of Entubation of the Trachea Through the Nasopharynx". That invention involves the introduction of an endotracheal tube through the nasopharynx, facilitated by an internally disposed fiber optic scope with a single eyepiece viewing means at the proximal end. The invention therein disclosed was devised for use in situations where the patient could assist in placement of the endotracheal tube by swallowing action when the patient is in an upright position. In emergency situations, assistance from the patient, even one able to maintain an upright posture, is unlikely. Intubation must be quick, and accomplished by mechanical means guided only by the attending physician or technician. Further, the invention disclosed in U.S. Pat. No. 3,776,222 makes use of a single eyepiece for viewing that which is illuminated by the fiber optic system, much like the single eyepiece of a telescope. If the attending physician removes his eye from the eyepiece to make an external assessment of the patient, a critical lapse in time occurs before the physician can refocus the internal image produced in the eyepiece. Such a lapse of time can affect the timely placement of the endotracheal tube and may even cause the physician to miss or misinterpret certain landmarks such that exact placement of the tube is hindered.
In the present invention, a camera disposed within the optical housing projects the image illuminated by the fiber optic system onto a television-like screen. This arrangement negates the need for focusing and refocusing the eye upon the objective, and allows a simultaneous viewing of the internal and external condition of the patient during the intubation procedure. In many applications, this invention has preferable use over existing fiber optic scopes, such as the bronchoscope and laryngoscope, because of the immediacy with which it can be put into operation. Existing bronchoscopes require a preparatory setup which is time consuming, and expertise in their use limits their effectiveness.
Modifications of the fiber optic system in this invention allows intubation through either the pharynx or nasopharynx in both emergency situations and intubations where the patient is awake. Further, modifications of the fiber optic system of the invention allow its use as bronchoscope, in non-emergency applications, for exploration, diagnostic testing, and surgical procedure.
It is an objective of this device to provide a means of visually facilitating the intubation of an endotracheal tube via the pharynx or nasopharynx in emergency situations in those types of patients whose larynx is difficult to view through use of a laryngoscope alone due to morphological irregularities or complications.
It is further an objective of this invention to provide a means of viewing through the camera the opening to the tracheal airway of the patient while being simultaneously capable of viewing the airway of the patient through use of a television-type screen illuminating the internal image.
It is further an objective to provide a margin of safety to the physician in successful placement of an endotracheal tube in an emergency situation in those types of patients whose larynx is difficult to view through use of a laryngoscope alone.
It is further an object of this device to provide a means of optically facilitating emergency intubations without the delay in setup of the instrument which is inherent in existing fiber optic scopes.
It is a further objective of this device to provide a means of optically facilitating endotracheal intubation in emergency situations by use of a unit with a self-contained power source.
Yet another objective is to provide a means of optically facilitating endotracheal intubation via the pharynx or nasopharynx in non-emergency situations in those types of patients who larynx is difficult to view through use of a laryngoscope alone due to morphological irregularities or complications.
Another objective of this invention is to provide a fiber optic bronchoscope device for use in non-emergency situations which allows the physician to simultaneously view the patient's internal tract while viewing the external condition of the patient by means of a television-type viewing screen.